McClish D K, Powell S H
Department of Biostatistics, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0032.
Med Decis Making. 1989 Apr-Jun;9(2):125-32. doi: 10.1177/0272989X8900900207.
The accuracies of physicians' predictions of mortality for 523 patients in a medical intensive care unit were compared with estimates derived from a logistic model. The model utilized a popular severity-of-illness measure, the APACHE II. Accuracy was assessed through its components resolution (discrimination) and calibration. Physicians could better discriminate survivors from nonsurvivors, as measured by the area under the receiver operating characteristic curve (0.89 for physicians vs 0.83 for APACHE II model, p less than 0.001) and by resolution (0.103 for physicians vs 0.130 for APACHE II model, p less than 0.001). Overall, the APACHE II model was better calibrated (0.003 for APACHE II vs 0.021 for physicians, p less than 0.001). While the APACHE II model was better calibrated in the central probability ranges, physicians could more accurately identify those most likely to die. Decisions on withholding or withdrawing treatment are being made daily in intensive care units based on physicians' subjective prognostic estimates. At least for experienced physicians at a major medical center, these estimates are comparable in accuracy to quantitative models.
我们将内科重症监护病房中523名患者的医生死亡率预测准确性，与从逻辑模型得出的估计值进行了比较。该模型使用了一种常用的疾病严重程度衡量指标——急性生理与慢性健康状况评分系统Ⅱ（APACHE II）。通过其组成部分分辨力（区分度）和校准来评估准确性。通过受试者操作特征曲线下面积（医生为0.89，APACHE II模型为0.83，p<0.001）以及分辨力（医生为0.103，APACHE II模型为0.130，p<0.001）来衡量，医生能够更好地区分存活者和非存活者。总体而言，APACHE II模型校准得更好（APACHE II为0.003，医生为0.021，p<0.001）。虽然APACHE II模型在中心概率范围内校准得更好，但医生能够更准确地识别那些最有可能死亡的患者。重症监护病房每天都根据医生的主观预后估计来做出关于停止或撤销治疗的决定。至少对于一家大型医疗中心的经验丰富的医生来说，这些估计在准确性上与定量模型相当。
